Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit. Upon arrival, there were two (2) staff and three (3) residents present. The Assistant Administrator Karina Antig was contacted and arrived at 10:35 a.m. Entrance interview conducted.

Beginning at 11:08 a.m., the LPA, along with Assistant Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are four (4) designated resident rooms and one (1) staff room inside the locked garage area, as well as an upstairs area solely dedicated to staff use. LPA observed the resident rooms to contain appropriate linens and furnishings.

RESTROOMS: The facility contains two (2) shared resident restrooms and one (1) staff restroom upstairs. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature initially measured slightly high, but was adjusted during today's visit. LPA will retest the water during the continuation visit.

COMMON AREAS: The common areas including the dining room and living room were observed to be properly furnished at the time of the visit. A fireplace in the living room had a screen. Two (2) fire extinguishers were observed to be fully charged and last serviced 05/20/2025. Service is scheduled. The LPA observed required postings throughout the common space. At 12:13 p.m., the hardwired combination smoke and carbon monoxide detectors were tested and all functioned properly.